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9445 SW LOCUST STREET co N r 0 ' c N r+ Cn cD m .M f t 9445 SW Locust Street CITY OF TIGARD -- PLUMBING PERMIT �A DEVELOPMENT SERVICES PERMIT#: PLM2004-00073 1312.5 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/18/04 SITE ADDRESS: 09445 SW LOCUST ST PARCEL: 1S126DG-04900 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 003 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: _ URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 1 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Water service repair on east side of building. _ FEES Owner: -- --- —�— —�— Description Date Amount B13H INVESTMENTS - - 9445 SW LOCUST 111LUM131 I'cmw I cc 2/18/04 $72.50 TIGARD, OR 97223 (TAXI 8R/o Stme Surcharl 2/18/04 $5.80 Total $78.30 Phone Contractor: DETEMPLE CO INC 1951 NW OVERTON ST PORTLAND, OR 97209 REQUIRED INSPECTIONS Water Service Insp Phone : 503-227-2641Water Inspection Reg #: MET 1986 LIC 2510 PLM 26-25PB This permit is issued subject to the regulations cortained in the Tigard Municip&I Code, State of OR. Specie'', Codes and all other applicable laws. SII work will be done in accordance with approved plans. This permit will expire if work is no, started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon 7 /J Issued By: 4) Permittee Signatur^ `— Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day 02,'13/04 IT 10: 19 FAX !)ll!)I e K i!:bins Permit Applicatit�n ` City of Tigard tra�iwa 13125 SW.31 L,II Hlvd.,Tigard,C.)R 97223 qutrJU : 7-11/3 hermit No f04,y�QQ y-��.�� Phone: 51)3.639.1171 FOX: 503.598.1960 ` flan Revirw - -- 24-Hour Inaptdion lino: 503.639.4175 ' llstdg• OIIms Pem,ii No.- harmed ww1v.ei,ligord onto Uate Ready/Hy: rwlc FS gee/'app•Z Mr- -- - - --- "�""'•^"---- Nutitiod/Mothod: �r R�yiplrnw,dal lidnrnnation TYPE o6 wO RK0 C3 1?R�• 9f`NEbt1E,F. Newconsuuction ❑Demolition For apecio/information Use checklist: Addition/allcrabnNreplacentenl --- -- --'— __ ihscrt�tlio° __ 1 To1aI-- _ 17 Other. Qty -l + New I-2-farn113•dwellings(includes 100 H.fur,x,ch utility wmnta ion) _ -- CAi 1>tgtlli Y OF'Cl`JiNitl`RYlty'1'►idlV SFR(1)hath 2 49.20 _ 1 and 2-lumily dwelling - Conunereial/industrial SFR(2)both 350.00 ❑Accaerery building []Multi-tnmily SFR(3)both 399.00 ❑Master builder �- - - Each additional lvttlt/kitche,n _ _ []Other: T 45.t1D ---'" � `""• Firo aprink)cr(_-sq It,l l a c 2 Mkift6 11YFOtYMATION AND I,OICATIt31Y Job site address 94484 SW Locust ST v� - -._-- -' --- - Site utilities Catch basin or arao drain 16.60 r- city/State/zip, _ ---- - --- Urywroll,leash line,to Irenoh drain _ 16.60 Suita/bldg./apt.tto. P1+c*t name:Commercial Building-- - Pooling drain(no.linear R.:_� paw 2 - Goss streeVdirections to job site: _ - "" Manuliwturml home utiliucs 110.00 -_._�— ---•_- Manitolta. r 16.60 drain anvux lar 16.60 Sanitary sewer(no.linear fl.: ) Page 2 ------ - - - Shun seweK(n) linear R.:,�` Pogo 2 Subdivision: -- _ �t t no.: Water snrvivw(no.linear tt, ppga 2 'Tax map/pateel Its.. Fixture or item -._..._._.._-DrSC RIPTION or WORK - -- - Absorption valve 16.60 Watc _.�..__...___ _ :_-- , _.. .._ 13ucktlow preventer - Page 2 '- r service repair stn East side of building _- D3uokwater valve- — -- - �_ 16.60 Clothes washer _ - Dishwasher y _ 160) J PI1 EJJ'# d id ENA I --'" Drinking li,unlain 16.60 Name: �- EjeclontAump - 16.60 Extwnsion tank - •- Addnhs: ___-._- 16.60 Fixtuiesewer cap 16,.60 Pity,3tate/ZIP• �- - t'Itx,r dmin/noor sink/hub 16.60 Him:l ) Fax ( ) l7atinq-.disposal 16.611 �] APPLICAMt - 16.60 - . _W D CONTACT PEIA1801V. Hose bib Business name -` -' Ice maker 1660 _.__._ -_._..--•__` ...-.:_--- - Interceptrtt/grenaattvp 16.60 Contact namo __.___-_ -- - Madical gas(value:S ) Page 7. - -- -- _ Addros -- _ ---. ..._- -- - -- - Primer 16.6(1 City/State/7-IP - _ - Roordrain(commcn:iat) - _ 1660 - Phone:( ) Fex1:( ) Sinklbusin/lovattay 1660 [Addrm mall - -- --'-- - - Tub/shower/shower pan 16.50;COIV7 ttACTtyR 16.60siness wl hl closernantc DeTemple Company.Inc. Wntcr(water 16.60 1931 NW Overtna Other.City/State/ZIP:Portland,OR 97264 __ Subtotal Phone:(8403)227.1641 `- r pax:(�O)274.7686 - �- Minimum pernik ILe: $72.50 ------, ---_ -- liesidmfinl baokllow minimu�emtit fee: $36.15 CCB Lic.:28410 umbin Lic.no.:26-25 PB — -- - roe)_--- ----yy-- g ---- plan review (2S°.1;nfpnrmit ke) Authorised signuturc�� — - - State sumimuge(11%ofPermit fee) s _ TUTAL11 PLI MIT I Print nnmc Shulynn Gntrin Ilpte tl2.11.04 M perrnit oppiicallm expires Its permit is not obtained within FEB 16 2004 CITY OF TIaARD SUII..DING DIVISION CITY OF TIGARD BUILDING ..,in Line: (503)639-4175 INSPECTION DIVISION I4usiness Line: (503) 639-4171 -- BITP -- Received�_�/�GI 4ate Requested __ �� AM_____ ._____ PM BUP _ Location �_ —_ Suite _ MEC Contact Person _— Ph( �) Z �� . lP`�`L Contractors Ph( ) SWR _ BUILDING Tena Owne7_T�.L� c��t�tlJ_d/, yf-,f�i �_ ELC Footing ELC Foundation Access: -- Ftg Drain EL.R Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors -- Ext Sheath/Shear Int Sheath/ShearFraming Insulation Insulation -- Drywall Nailing Firewall Fire Sprinkler ------ -- Fire Alarm Susp'd Ceiling - - -- 17 Roof Other. 'nal PASS PART FAIL PLUMBING _ - Post&Beam Under Slab _- Rough-In - Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain -- - - --- ------- Shower Pan Fin S ART FAIL *EPCHANICAL Post&Bearn - - Rough-In - --- - ----------- -- _ I Gas Line Smoke Dampers Final PASS PART FAIL - — ELECTRICAL Service --� --------- Rough-In UG/Slap -- -- Low Voltage _ Fire Alarm - -- F;ral ❑ Reinspection fee of$_ required before next Inspection. Pay at City Hail, 13125 SW Hall Blvd. PASS PART FAIL Please call for reinspection RE:—- Unable to Inspect-no access Fire Supply Line ADA xY � Approach/Sidewalk Date a AV - Inspector f!_.lQ�' __ _- - Ext _ -- Other: _ Final DO NOT REMOVE this hispection Record from the job site. PASS PART FAIL CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hot-r Inspection Line. 639-4175 Business Line: 639-4171 - BUr _— Date Requested _ AM PM BLD Location evCU 5 — _ Suite — MEC Contact Person — — Ph 21_ 71 PLM — Contractor �� < <�- — Ph — SWR _ BUILDING _ — Tenant/OwnerELC 610(-01O Retaining Wall — — ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes — -- Slab G-- C r /� SIT Post& Beam --- Ext Sheath/Shear a� Int Sheath/Shear P Framing � Insulation --_-�-- -- -_-Drywall Nailing --- ----- — --.-_...----------- --- Firewall Fire Sprinkler Fire.Alarm ""- Susp'd Ceiling - Roof — Misc - - ------ _._r�-- _ — ----- -- Final PASS PART FAIL --— -_—�--- -- ---- PLUMBING Post& Beam Under Slab TapOut - ---- ----____--------_._-- -- --- -._ ---- Water Service Sanitary Sewer ---------------_.___..._._._- .—�— .--- Rain Drains Final --------------------------- - PASS PART FAIL MECHANICAL Post& Beam ---- ---------- -__._._—__—__ Rough In Gas Line - ---- Smoke Dampers Final --------- --------- ---- — - - PASS PART FAIL ervice houghIrr -- -- ------- ------------— ------------- ----- --- UG/Slab Low Voltage Fire Alarm Fin S 4,VAR T FAIL - -- ----- --------- -------- ------ :kfill/Grading ;tary Sewer m Drain ] Reinspection fee of$ _required before next inspection Pay at City Hall, 1?125 SW Hall Blvd Catch Basin Fire Supply Line ( ] please call for reinspection RE_ _ T-- ] ] Unable to inspect no access ADA Approach/Sidewalk ' z J � Other Date _� _---__Inspector ___— —� — Ext Final PASS PART FAIL no NOT REMOVE this inspection record from the job site. CITYOF TIGARD PLUMBING PERMIT — DEVELOPMENT SERVICES PERMIT#: PLM2000-00438 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/4/00 SITE ADDRESS: 0944.5 SW LOCUST ST PARCEL: 1S126DC-04900 SUBr)IVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 003 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER ri r)SETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace existing bar size sink with new full size sink. Owner: `_--_ FEES _ BBH INVESTMENTS Type �By Date Amount Receipt 9445 SW LOCUST PRMT CTR 12/4/00 $72.50 27200000000 T!C,A,RD, OR 97223 5PCT CTR 12/4/06 $5.80 27200000000 Total $78.30 Phone 1: — Contractor: CANYON PLUMBING + HEATING 8101 SW NIMBUS AVE #11 BEAVE RTON, OR 97005 REQUIRED INSPECTIONS Phone 1: 646-5096 Top-out Insp -- Reg #: L IC 4219 Final Inspection PLM 34-317pb This permit is issued subject to the regulations contained in the Tigard Murricipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done it) accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952.0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1997. Issued By: �.,(vfr"E1(� ' permittee Signature: \ Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application IDatereceived:ZR-c� �U Permit no).: City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 — CiryojTigard phone: (503) 639-4171 Projecl/appl.no.: Expire date: Fax: (503) 598-1960 Date issued: By:_ Receiptno.: Land use approval: Case file no.: Payment type: 5113 luj�� U 1 &2 family dwelling or accessory J&Vomnicrcialhndustrial U Multi-family U Tenant improvement U New construction ❑Addition/allerntion/rcplacement U food service U Other 1 Job address: Ay, U5- -- _ Description Qty- Fee(ea.) 'Total Bldg.no.: Suite no.: New—1-and 2-family dwellings only: Tax map/tax lot/account no.: (Inelnd44s 100 ft.for each utility connection) SFR(1)bath Lot: B� lock: Subdivision: SFR(2)bath Project name: L J4(j[2 ! A►J(�T SFR(3)bath _ City/county:'-" 1� 1 ZIP: Each additional badi/kitchen Delcription and ocation of work on reises: _ Sheutilities: Catch basin/arca drain Est.date of completion/inspeclion: Drywells/leach lin:/trench drain _ - 1 Ftxiting drain(no. lin. I't.) Manufactured home utilities Business name: - _ Manholes Address: ' =4 Rain drain connector City: State:( . 71P:CI � �j_� Sanitary sewer(no.lin.ft.)— ��-- Phone: Faxao-j 1-4;T 71 E-mail: Storm sewer(no.lin. ft.) CCB no.: Cl al�lPlumb.bus.reg.no: _ Fater service(no.lin.ft.) City/metro lic.no.: Fixture or item: Absorption valve Contractor's representative signature: Print name: Back flow prcvcnter J' l (?_, - Date: - -� - Backwater valve Basins/lavatory _ Name: U- Clothes washer Address: FA C,1 J i`J iry� — Dishwasher City: _ State:U ZIF: Drinking fountain(s) - Ejectors/surnp Phone: , - Fax: Email Expansion tank — Fixture/sewer cap Name(print): Floor drains/floor sinks/hub _- Mailing address: -- '— Garbage disposal -- Iiose bibb City: �- State: ZIP: Ice maker _ Phone: Fax E-mail: Interceptor/grease trap Owner instal lation/residential maintenance only: The actual instrJlation Primer(s) will he made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property i own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _ Owner's signature: _ Date: _ Sump 'rubs/shower/shower pan — Name: Urinal _ -- - -- Water closet Address: _ Water heater City: _ --mate: I ZIP: - Other: Phone: Fax: I F-mail: Total Not all Jurisdictions accept credit cards,please tali judsdt•aion for more informallon Minimum fee...... .........$ Notice:This permit application - � UV-4 UMasterCardI Ian review(at — %) $ e.nares tf a permit is not obtained Credit:ard number:__ _ l / Slate surcharge(8%)....$ Expires within ISO days after it has been Name of cardholder as shown no credit card accepted as complete. TOTAL .......................$ C'ardhuldei signature — Amount 4404616(&MCOM) PLUMBING PERMIT FEES: —�-- PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES individual— QTY _lea AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT 16.60 for each utility connection Lavatory _ A One(1)bath _ h —_ $249.20 Tub or Tub/Shower Comb, 16,60 Two(2)bath_ $350.00 Shower Only 16.60 Three 3 bath _ _ $399.00 _ Water Zloset 16.60 — SUBTOTAL Urinal 1660 8%STATE SURCHARGE Dishwasher Y 16.60 — PLAN REVIEW 250%,OF SUBTOTAL _ — TOTAL Garbage Disposal 16.60 Laundry Tray — 16.60 Washing Machine 16.60 Floor Drain/FloorSink, 2" 16.50 PLEASE COMPLETE: 3" 16.60 4" 16.60 Water Heater O conversion O like kind — 16.60 Quanti�b Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ ennit. __ Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 _ Combination _ Roof Drains 16.60 Shower Only _ Drinking Fountain 16.60 Water Closet 16.60 — Urinal Other Fixtures(Specify) Dishwasher _ Gatua e Disposal Laundry Room Tray _ — Washing Machine _ Floor Drain/Sink: 2" _ Sewer- 1st 100' 55,00 3^ Sewer-each additional 100' 46.40 — 4" Water Service- 1st 100' 5500 Water Heater _— _ — — Gther Fixtures Water Service-each additional 200 46.40 S acid Storm 8 Rain Drain-1st 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 -- Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 -- -- Catch Basin 16,60 Inspection of Existing Plumbing or Specially 12.50 Requested Inspections erlhr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65,25 —.— Crosse Traps 16.60 —--- -- — -- QUANTITY TOTAL Isometric or riser diagram Is required II Quantity Total Is >g _ — —` ^---�--- — "SUBTOTAL 8%STATE SURCHARGE ------ --- —' "PLAN REVIEW 25%OF SUBTOTAL Required only if fixture qty total is>9 TOTAL $ *Minimum permit fee Is$72 50 4 8%state surcharge,except ResidentIM Backflow Prevention Device,whi h Is$38.25.a%state surcharge "All New Commercial Buildings require plans with Isometric or riser diagram and plan review I:\dsts\forms\plm-fees.doc 10/10/00 Accumulative Sewer Tally f Tenant NamI ,e P A This SWR# Address: This PLM# Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New # Value Capped off value added# added #S total Count off#s count value values Baptistry/Font 4 Bath -Tub/Shower _ a -Jacuzzi/Whirlp.:of 4 _Car Wash - Each Stall _ �6 _ Drive Through 16 Cuspidor/Water Aspirator 1 J Dishwasher-Commercial 4 -_Domestic 2 Drinking Fountain Eye Wash �- - 1 �— — --- -- Floor Drain/sink -2 inch 2 -- _ 3 inch 5 !_ 4 inch 6 Car Wash Urn _ 6 Garbage Disposal 16 _ • Domestic(to 3/4 HP) _ — _ Commercial(to 5 HP) 32 Industrial (over 5 HP) ^` 48 Ice Machine/Refrigerator D*ains 1_ Oil Sep(Gas Station) 6 _ — Rec. Vehicle Dump Station 16 _ — — Shower- Gang (Per Head) 1 — _- Stall--- 2 Sink- Bar/1-avatory — 2 Bradley 5 _ A_— Commercial 3 _ Service 3 Swimming Pool Filter 1 Washer- Clothes 6 Water Extractor 6 Water Closet - Toilet 6 Urinal 6 TOTALS ----------- C�ll� ----- ' � ��J 1 �� - �U Total fixture values i�—`divided by 16 �� -EDU z HISTORY PLM# _ EDU# SWR# PL-M# EQU# _ SWR# PLH# EDU# SWR# _ _PLM#_ __ _ EDU# SWR# PLM# _EDU# _ SWR# PLM# _ ED_U#_ SWR# PLM# EDU# SWR# —PL M—# _- EDU# SWR# i\dsts\swrlaly doc CITYOF T I G A R D ELECTRICAL PERMIT PERMIT#: ELC2000-00670 DEVELOPMENT SERVICES DATE ISSUED: 12/5/00 13125 SW Hall Blvd.,Ticiard. OR 97223 (503) 639-4171 PARCEL: 1S126DC-04900 SITE ADDRESS: 09445 SW LOCUST ST SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT : 003 JURISDICTION: TIG Proiect Description: installation of two branch circuits. RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL_ (10): SERVICEIFEEDER _ _ BRANCH CIRCUIT'S _ ADD'L INSPECTIONS _ 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT: 601 - 1000 amp- PLAN REVIEW SECTION _ 1000+ amp/volt: _ >=4 RES UNITS > 600 VOLT NOMiNAL: Reconnect only: SVG/FDR >=_225 AMPS: CLASS AREA/SPEC Owner: Contractor: BBH INVESTMENTS THREE DOG ELECTRIC 9445 SW LOCUST 5250 SW CAMERON RD TIGARD, OR X7223 PORTLAND, OR 97221 Phone: Phone: Reg #: IUP 4613S LIC 138509 ELE 26-1046C FEES Required Inspections ____ __ Type�By — Date Amount Receipt Wall Cover PRMT CTR 12/5/00 $53.50 2720000000( Elecl'I Final SPCT CTR 12/5/00 $4.28 2720000000( Total $57,78 Thi:,Permit is issued sub;ect to the regulations contained in the Tigard Muniapal Code,State of OR Specialty Codes and all otter applicable laws All work will be done in accordance with approved plans This parmit will expire if work is not started within 180 days of issuance,or if work is suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-U080 You may obtain copies of these rules or direct questions to OUNC at(503) 246-1987. r� ll - PERMITTEE'S SIGNATURE > ISSUED BY: � ( ��E _ OWNER INSTALLATION ONLY The installation is being made on property I own which is riot intended for sale, lease, or rent. OWNER'S SIGNATURE: _ DATE: CONTRACTOR I10,3TALLATION ONLY SIGNATURE OF SUPR. ELEC'N: �..- - DATE:—1 Z- S 2-(100 LICENSE NO: //('� ^' Call 639-4175 by 7:00pm for an Inspection the next business day Electrical Permit Application "D�atereceived:AP.- Permit no.: t1Zdzi�3�k City of Tigard Project/appl.no.: Expire date: Cityu/Tigrrrd Address: 13125 SW Hall Blvd,Tigard,GR 97223 Date issued: By: Rcceiptno.: Phone: (503) 639-4171 — — Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: U I &2 family dwelling or accessory /i Cruunivrcial,industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/replacement U Other: a Partial JOB SITE INFORMATION Job address: %4 Sw t—� L)jt Bldg. no.: Suite no.: T'ax map/tax lot/account no.: L.ot: Block: Subdivision: - Project name: _ Description and location of work on premisesrtu_x) C UeLi, IS 0 4w—+ I AH (31 Estimated date of completion/inspection: 1. 1 Job no: Fee Max Business name: T4VE C 1�G C: Fl FL.r_:i I t(�_ __ Description QlY. (e r.) Total no.fns Address: -— Nen midential-single or multi-family per Ivrelliogunit.Include attached garage. C'tYPARTLIlubState iR, ZIP:4 7- tieniceincluded: Phone ' i Fax: E-mail: Iax)sg.ft.or less CCB no.: t 3 4 tj Elec.bus.lie.no: Each additional 500 sq.ft.or portion thereof Limited energy,residential _ 2 City/metro IiC,no.; Limited energy,non-residential 2 ZeXJG Fach manufactured home or modular dwelling Signa are of supervising electrician(required) _ Date Service nnd/or feeder - 2 Sup elect.name(pt int): Licensenu:L( Serrlcesorfeeden-Installation, is Ion or relocation: W lie]Watiml[liliell In 200 amps or less 2 Nance(print): 3UC- 201 amps to 400 amps 2 Mailing address: c{y r 401 amps to 600 amps 601 amps to 1000 amps City:l>G�L�I_tiaN ;� I Stateoz ZIP:c(TZL3 Over 101x)amps orvolts -- 2 Phone: Fax: I E-mail: Reconnect only I Owner installation:Thi installation is being made on property I own I1emporaryservices orfeeders- which is not intended fur sale,lease,rent,or exchange according to Installation,alterali•m,orrelocation: ORS 447,455,479,67C,701. 20t)amps or less 2 201 amps to 400 amps 2 Owner's si nature: Date: 1 40�to 600 amps 2 of"101 Branch circuits-new,alteration. Name: or extension per panel: A. Fee for branch circuits with purchase of Address: _service or feeder fee.each branch circuit 2 City: State: ZIP: — H. Fee for branch circuits without purchase - of service or feeder fee,first branch circuit: 2 Phone: Fax: F-trail: Fach additional branch circuit. III %N REV111,11 (Please cheek A flint appliC.(Service or feeder not included): U Service over 225 amps•commereiat U Health-care facility Fach pump or irrigation circle _ 2 U Service over 320 amps-rating oft&2 U Hazardous location Fach sign or outline lighting 2 - family dwell ings U Building over 10,(K)0 square feet fourot Signal circuit(s)or a limited energy panel U Systemover600 volts nominal mora residential units in one structure alteration,or extension* U Building over three stories U Feeders,400 amps or morn. *Description: U Occupant load over 99 persons U Manufactured structures or RV park Fich additional Inspection over the allowable fu any of the above: U FgresAigh0ngplan U Other: __ Perinspection Submit.--sets of plans with any of fhe above. Investigation fee The above are not applicable to temporary construction servo ze. other -- Nor all jurisdicttov accept credit cards,please call jurisdiction fot mor^infarmation. Notice:This permit application Permit fee.....................$ • _ L1 Visa U MasterCard expires if a pem,it is not obtained Plan review(at _ 46) $ r ledii card number -- - ----L-1— within I NO days after it has been Stale surcharge(846)....$ Name of cardholder ass mvn on credit cud Expires accepted as complete. TOTAL . $ �) f - ---C'udh,ider signature Amount 44n-4613(WWOM) Electrical Permit Fees: Limited Energy Fees: "--- —�� TYPE OF WORK INVOLVED -RESIDENTIAL ONLY _ Comp ete Fee Schedule Below: Restricted Energy Fee....................... .............................. $75.00 Number of ln5E2ctions per ponnit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq ft or less $145 15 __ 4 Audio and Stereo Systems Each adddional 500 sq n portior thereof $33 40 _ 1 Burglar Alarm Limited Energy $75.00 Each idanuf d Hone or Modular Garage Door Opener' Dwelling Service or Feeder _ $9090 Services or Feeders Heating,Venli!ation and Air Conditioning Systern' Installation,alteration,or relocation 200 amps or le-,s _ $� -i0 2 VacurIm Systems' 201 amps to 400 amps $106.85 2 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $24060 2 ❑ Other_ Over 1000 amps or volts $454.65 _ 2 Reconnect only $6685 2 Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Temporary Services or FeeFee for each system................................................ ......... $75.00 Installation,alteration,or relocation 200 amps or less $66.85 _ ___ 2 (SEE OAR 918-260-260) 201 amps to 400 amps $10030 401 amps to 600 amps $133 75 _ r Check Type of Work Involved: Over 600 amps to 1000 volts, LJ Audio and Stereo Systems see"b"above. Branch Circuits F� Boiler Controls New,alteration or extension per panel a)the fee for branch circuits with purchaso of service or Clock Systems feeder fee. f� Each branch rircutl ,. $665 L J_ _ 7 Data Telecommunication Installation b)The fee for branch circuits without purchase of service �' Fire Alarm Installation or feeder fee. tL LL; ct First branch rircuil _ I $4685 T C� HVAC Each additional branch circuit _� _ $6.65 5, Miscellanentrs L� Instrumentation (Service or feeder not included) Each pump or Irrigation circle _ $53.40 _ Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s)or a limited energy Landscape Irrigation Control' panel,alteration or extension $7500 Minor Labels(10) $12500 _ -- � Medical Each additional Inspection over the allowable In any of the above F--j Nurse Calls Per inspection _ $62.50 Per hour _ $6250 In Plant _ _^ $7375_ Outdoor Landscape Lighting' Fees: Protective Signaling �' Jr ❑ --- Enter total of above fees $ Other------- 8%State Surcharge $ __–_Number of Systems 25%Plan Review Fee No licenses are required Licenses are required for all other installations See"Flan Piwiuw"section on $ front of application ---'-- _ � Fees: Total Balance Due $ 1 Enter total of above fees $ — Trust Account#_ _. 8%Slate Surcharge $ Total Balance Due $- — i:\dsts\fonns\elc-fccs.doc 10/09/00 CITY OF TIGARD BUILDING IN'')PECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP � Date Requested 17= _ AM PM BLD( �,� Location ' �� Suite MEC�- - - -__--_ Contact Person _ /�T �!�� PhZ 37�� PLM �U~L�V Contractor _ —� Ph _—_— SWR BUILDING TeriantlOwner _ --� — ELG Retaining Wall ELR Footing Access FPS Foundation Ftg Drain --- --- SGN C i0 Drain Inspection Notes -��— Slab -----__...____-- SIT Post 8 Beam _--��----- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing ----_ _ _---_ Firewail Fire Sprinkler ---- - -- --- - — — - ------- - - --....---- - Fire Alarm Susr'd Ceiling -- ---------- --- ------ --- -__ --- Roof Misc:____ - Final - PASSPART FAIL -- ------_ _. ___ ___._._.--___-- -----------_— - PLUMBI Pnst& Rearn Under Slab Top Out Water Service __------------- --- ------.......--- Sanitary Sewer Pain Drains In SS 11PART FAIL WIEMMLAICAL Post& Beam - Rough In Gas Line ----- - -- -- ---- -- - -- Smoke Dampers Final ---.-...._...-- -- - -- — - -- ----___ -- -------- --- ---- ------- PASS PART FAIL_ ELECTRICAL -- Service Rough In UG/Slab _----------- Low Voltage Fire Alarm -- - --------- �— — _— Final PASS PART _ FAIL ---— -- - -- -- ----- ----- —-- -- --SITE Backfill/Grading -- ----.—_—� --- �-- --- ------- Sanitary Sewer Storm Drain ( )Reinspection fee of$ --required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ]Please call for reinspection RE [ � Unable to inspect-no access ADA Approach/Sidewalk Date _ ��OL' Inspector Ext Other F inal PASS PART FAIL. DO NOT REMOVE this Inspection record from the job site